Insurance Fraud & Investigations Unit
Amy Stegall, Program Manager
Producers, Adjusters, Appraisers & Insurance Agencies
The Fraud & Investigations Unit investigates reports and allegations of misconduct by individual licensees including producers, adjusters and appraisers. The unit levies administrative sanctions against licensees as necessary, and/or refers criminal actions to the appropriate jurisdiction for possible prosecution. Types of investigations of individual licensees routinely handled by the unit include:
- Failure to remit premiums or place insurance
- False/fictitious binders
- Misappropriation of insurance funds
Reminder: companies have a responsibility to report producer terminations “for cause.” Additionally, companies are required to report any producer for failure to remit premiums.
Actions taken against licensees can include: fines, probation, suspension or revocation of licenses issued by the Department.
Surety Bail bonds
The Fraud & Investigations unit conducts investigations of licensees (bail bond agents/agencies) when possible violations of law are alleged or suspected. The unit also licenses bail bond agents and agencies. Typical allegations against bondsmen investigated by the unit include:
- Failure to remit premiums
- Theft of collateral
- Undercutting (failure to charge the proper premium)
Reminder: Surety companies are required to conduct semi-annual audits of their agents and report discrepancies to the Department within 45 days. Surety companies are also required to file an annual report with the Department by March 31 outlining the total amount of premiums collected by such insurer on bonds issued in the previous year.
Questions may be sent to: firstname.lastname@example.org
The Fraud & Investigations unit promotes insurance fraud prevention, detection, and reporting through consumer outreach and education. The unit also provides assistance to insurer’s anti-fraud or special investigative units (SIU’s) and facilitates cooperation and communication among insurers, state and federal agencies, law enforcement, and insurance industry groups. The Fraud Unit coordinates anti-fraud efforts among, and offers assistance as appropriate to, the following entities or agencies: National Insurance Crime Bureau (NICB) local, state and federal law enforcement, and other state agencies such as Department of Public Health, Department of Consumer Protection and Department of Motor Vehicles.
Additionally, the unit reviews allegations of insurance fraud and makes referrals to other agencies or law enforcement for criminal prosecution as needed. Typical referrals include, among others, reports of arson, staged auto accidents, false reports of auto theft and improper medical billing.
Insurance Companies are reminded that they are required to report individual cases of insurance fraud as well as file an annual insurance fraud report with the Department by March 31st.
- Mandatory Annual Fraud Reporting Form For Companies
- To file a Fraud Report Online
- NAIC online fraud reporting (OFRS)
Questions may be sent to: email@example.com
LICENSING OF OTHER INSURANCE BUSINESS ENTITIES
The Licensing Division handles the licensing or registration of the following business entities:
- Medical Discount Plans (MDPs)
- Pharmacy Benefit Managers (PBMs)
- Preferred Provider Networks (PPNs)
- Life Settlement Providers (LSPs/viaticals)
- Third Party Administrators (TPAs)
Questions may be sent to: firstname.lastname@example.org
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